Objective To explore the correlation between lipoprotein a (Lpa),fibrinogen (FIB) and D-dimer (D-D) and vascular cognitive impairment in patients with ischemic cerebral small vessel diseases (CSVD).Methods Totally 300 patients with ischemic CSVD who were admitted to the Department of Neurology,Affiliated Hospital of North China University of Science and Technology were selected as the research objects,and 70 healthy outpatients in the same period were selected as the control group.Cognitive function was assessed with Mini Mental State Examination (MMSE).According to the results of MMSE,patients with ischemic CSVD were divided into cognitive normal group (106 cases) and cognitive impairment group (194 cases).The cognitive impairment group was further divided into mild cognitive impairment group (100 cases),moderate cognitive impairment group (60 cases) and severe cognitive impairment group (34 cases).Lpa level was detected by latex immunoturbidimetry,FIB level by coagulation and D-D level by ELISA.The results were compared and analyzed.Results (1) Compared with the control group (Lpa:(101.67±37.37) rmg/L,FIB:(3.02±0.67) g/L,D-D:(231.49±95.00) mg/L),the levels of Lpa,FIB and D-D in normal group (Lpa:(150.58± 89.55) mg/L,FIB:(3.48 ± 0.80) g/L,D-D:(287.79± 125.25)mg/L) and cognitive impairment group (Lpa:(257.98 ± 189.23) mg/L,FIB:(3.86± 0.97) g/L,D-D:(347.23± 120.69) rmg/L)increased significantly (all P＜0.01).Compared with the cognitive normal group,the levels of Lpa,FIB and D-D in cognitive impairment group increased significantly (all P＜0.01).(2)Compared with mild cognitive impairment group (Lpa:169.08±51.63 mg/L,FIB:(3.10±0.69)g/L,D-D:(288.91±92.58) mg/L),the levels of Lpa,FIB and D-D of in moderate cognitive impairment group (Lpa:(236.78± 107.15) mg/L,FIB:(3.52±0.67) g/L,D-D:(345.03± 132.68) mg/L),severe cognitive impairment group (Lpa:(292.65±108.19) mg/L,FIB:(4.04±1.08) g/L,D-D:(401.58±84.87) mg/L)increased significantly (all P＜0.01).Compared with the moderate cognitive impairment group,the levels of Lpa,FIB and D-D in the severe cognitive impairment group increased significantly (all P＜0.01).(3) The ROC curve was fitted with cognitive impairment as state variable.The area under the ROC curve of Lpa was 0.706,P＜0.01,95％ CI was (0.646-0.766),the area under the ROC curve of FIB was 0.613,P=0.001,95％ CI was (0.548-0.679),and the area under the ROC curve of D-D was 0.670,P＜0.01,95％ CI was (0.604-0.736).(4) Lpa,FIB and D-D were positively correlated with the degree of cognitive impairment in patients with ischemic cerebral small vessel diseases (rLpa =0.522,P＜0.01;rFIB =0.410,P＜0.01;rD-D =0.488,P＜0.01).Conclusion Serum Lpa,FIB and D-D are closely related to the degree of vascular cognitive impairment and cognitive impairment in patients with ischemic CSVD,which may be involved in the occurrence and development of cognitive impairment.Detection of serum levels of Lpa,FIB and D-D is of great clinical value in the early diagnosis,assessment and treatment of cognitive impairment in ischemic CSVD.

COVID-19 associated Guillain-Barré syndrome (GBS) caused by peripheral nerve damage after SARS-CoV-2 infection is one of the most common COVID-19 related nervous system inflammatory diseases, with high incidence of respiratory failure and mortality. Positive SARS-CoV-2 RNA in cerebrospinal fluid of COVID-19 associated GBS patients has been rarely reported. This paper reports 4 patients with COVID-19 associated GBS in China who developed neurological symptoms 4-15 days after fever and were confirmed SARS-CoV-2 infection. All patients presented with progressive weakness of both lower limbs, 3 patients with autonomic dysfunction such as defecation and urination disorders, and 1 patient with polycranial neuritis and Miller-Fisher syndrome such as bilateral facial palsy, dysphagia, diplopia and ataxia. Nerve conduction velocity and F wave were abnormal in 3 patients, and motor conduction pathway was abnormal in 1 patient. Anti-ganglioside antibodies were tested in 3 patients, and GD1a-IgG was positive in 1 patient. All 4 patients underwent metagenomic next-generation sequencing examination in blood and cerebrospinal fluid. SARS-CoV-2 RNA was positive in blood and cerebrospinal fluid of 3 patients, and SARS-CoV-2 RNA was positive in cerebrospinal fluid of 1 patient.

Objective:To compare the changes of morphology of pharynx in patients with obstructive sleep apnea hypopnea syndrome （OSAHS） and healthy individuals during oral or nasal breathing, and explore the relevant influencing factors. Methods:Twenty-nine adult patients with OSAHS and 20 non-snoring controls underwent MRI to obtain upper airway structural measurements while the subjects were awake and during mouth breathing with a nasal clip.The following were analyzed. ①The changes of upper airway structure of oral and nasal respiration in non-snoring control/OSAHS patients were observed; ②The differences and influencing factors of upper airway structure changes between OSAHS patients and controls were compared during breathing. Results:The control group consisted of 15 males and 5 females, with an apnea-hypopnea index （AHI）<5 events/h, while the OSAHS group comprised 26 males and 3 females with an AHI of 40.4±23.1 events/h and the mean lowest arterial oxygen saturation （LSaO2） was 79.5% ±10.0%. In the both groups, the vertical distance between the mandible and the posterior pharyngeal wall decreased （P<0.05）; The long axis of tongue body decreased （P<0.05）, and the contact area between tongue and palate decreased. There was no significant change in the total volume of the retropalatine（RP） and retroglossal（RG） airway in the control group （P>0.05）. However, the minimum cross-sectional area and volume of the RP airway in OSAHS decreased （P<0.001）. The lateral diameters of uvula plane in OSAHS decreased during mouth breathing, which was contrary to the trend in the control group （P=0.017）. The AHI of patients was positively correlated with the reduction of the volume of the RP airway during oral breathing （P=0.001）; The reduction of the distance between the mandible and the posterior pharyngeal wall was positively correlated with the length of the airway （P<0.001）. Conclusion:Mouth breathing leads to the shortening of the long axis of the tongue, the reduction of the contact area between the soft palate and the tongue, vertical distance between the mandible and the posterior pharyngeal wall, and the cross-sectional area of the epiglottis plane. These changes vary between OSAHS patients and controls. During mouth breathing, the diameters, areas and volumes of the RP area decreased, and were more significant in severe cases.
Male ; Adult ; Female ; Humans ; Mouth Breathing ; Sleep Apnea, Obstructive/surgery* ; Pharynx/surgery* ; Palate, Soft ; Uvula/surgery* ; Syndrome

【Objective】 To explore the safety of transrectal ultrasound-guided transperineal injection of sodium hyaluronate to expand the Dirichlet gap in laparoscopic radical prostatectomy. 【Methods】 A total of 14 healthy male purebred beagle dogs were selected and randomly divided into 2 groups, with 7 in either group.The control group was treated with conventional laparoscopic radical prostatectomy, while the experimental group was treated with laparoscopic radical prostatectomy after 2.5 mL sodium hyaluronate was injected into the Dirichlet gap under the guidance of transrectal ultrasound.The total operation time, prostate separation time, intraoperative blood loss and rectal status of the 2 groups were observed. 【Results】 After the injection of sodium hyaluronate into the Dirichlet gap between the prostate and the rectum, no rectal tissue was found in the prostate, and no obvious damage was found in the posterior rectum in either groups.The postoperative hemoglobin (HGB) was [(118.70±2.56) g/L vs.(122.10±2.19) g/L, P=0.02]; the total operation time was [(141.40±9.80) min vs.(119.10±9.16) min, P<0.05]; the prostate separation time was [(24.99±1.75) min vs.(16.64±2.34) min, P<0.05]; the amount of bleeding was [(47.43±4.32) mL vs.(34.86±5.18) mL, P<0.05] in the control group and experimental group. 【Conclusion】 Laparoscopic radical prostatectomy performed after 2.5 mL of sodium hyaluronate injection into the Dirichlet gap under the guidance of transrectal ultrasound can shorten the total operation time, the separation and resection time of the prostate, and reduce the amount of bleeding, which can improve and reduce the incidence of rectal injury, and prove the feasibility of this approach for prostatic cancer.